Your Angry Heart

Anger can prove fatal to the heart, particularly when using heavy exercise to calm yourself down. To understand why, we need to turn to the strange history of A versus B – Type A and Type B personality. People still proudly or fearfully describe themselves as “Type A or Type B.” They may not realize the implications of that distinction.

Driven to Death

In the 1950s, San Francisco cardiologists Meyer Friedman and Ray Rosenman recognized what they thought was a dramatic risk factor for heart death – personality. Part of their intution came from observing their waiting room furniture. Chairs worn down at the front of their seats were more commonly used by “coronary” patients, the kind who kept demanding why they were waiting so long for their appointments. Could impatient, hostile, driven people prone more prone to heart attacks and cardiovascular death?

Over time Friedman and Rosenman became convinced that was so. “Type As” who quickly got upset, loved to multitask, were competitive and time urgent, “clearly” had more heart attacks than Type Bs, who were calmer, worked steadily, and did not feel depressed if they did not achieve great distinction. The pair did study after study presumably proving their thesis. Eventually many Americans were convinced they were – or knew – cardiac threatened “Type As.” Gradually Friedman, who ran an institute which helped train Type As to “become more like Type Bs,” suggested his charges drive mainly in the slow lane. He even picked the great French novel “Remembrance of Things Past” as a guide for his charges to achieve balance in life. With classic American ingenuity, Marcel Proust was repositioned as a public health tool (I admit I, too, have used Proust, occasionally suggesting “A La Recherhe Du Temps Perdu” as bedtime reading for insomniacs.)

However, Friedman and Rosenman’s choice of research patients eventually became suspect. Friedman could supposedly tell type As “from a photograph.” Determining who was type A for one major study was “determined by Ray Rosenman interviewing everybody and pronouncing ‘A or B’ based on his gut feel,” as the late cardiovascular epidemiologist Richard Shekelle told me. When criteria were developed trying to objectively define type As from Bs through questionnaires, some studies started showing the mild mannered Bs as suffering more heart attacks than their driven, competitive Type A cohorts.

But worse was to come.

It’s Not the Cigarette – It’s Your Personality

What many had not known was that the research down on Type A and B personality was underwritten by the tobacco industry for nearly four decades. Big Tobacco was desperate to point out that other factors caused heart disease besides smoking. Part of their strategy was to focus on “stress” as inimical to the heart. The distinction between Type A and Type B was tailor made for their purposes. Both Philip Morris and RJ Reynolds funded programs to modify the behavior of Type As, and used Type A personality as a cause of heart disease in litigation defense work. In the 1990s, Friedman – who considered himself a Type A – was found falsely claiming his research was mainly federally funded, rather than by the tobacco industry. Other could not substantiate his findings.

Hostility and the Heart

Professor Rutherford Williams at Duke, however, thought something about Type A and B behavior might translate into heart disease. He attempted over many studies to see whether some aspect of Type A behavior was linked to heart disease. One of his conclusions was that hostility – particularly hostility that did not have overt expression – markedly increased heart attack risk. Others have come to feel hostility alone is a prime factor, which brings up a recent study in the journal Circulation.

International Anger and the Heart

The recent INTERHEART study in Circulation, led by Andrew Smyth, looked at questionnaires on more than twelve thousand people in a case control study embracing 52 countries. When observing the period of one hour before heart attack, 13.6% were engaged in physical activity and 14.4% were angry or emotionally upset. For the different groups, the odds ratio of heart attack was 2.31 and 2.44 respectively, with relatively strong confidence intervals. If people were both angry and exercising, the odds ratio went up to 3.05.

It’s been known for a long time that exercise itself is an immediate risk for heart attack. If you run a marathon you’re more likely – while running the marathon – to get a heart attack than if sitting in your chair reading Proust. However, the advantages of exercise are so overwhelming in preventing long term heart disease – and much else – that the tiny increase provoked during exercise is considered acceptable.

The data on anger are different. People who are angry have more heart attacks. If you suddenly become angry you’re more prone to heart attacks in the ongoing period.

Bottom Line

The saga of Type A and Type B personality shows some of the pitfalls of popular psychologizing. Meyer Friedman lost great credibility when his ties to Big Tobacco were discovered. Yet ultimately work he led provoked research that showed anger is bad for health, and hostility unhealthy for the heart.

If you get very angry, quickly mollifying that anger through heavy exercise may not be a good idea.